COVID-19 Pandemic Disruptions in Access to HIV Testing and Treatment Services and Mental Health of Sexual and Gender Diverse Persons in Kazakhstan

BACKGROUND AND PURPOSE: Eastern Europe and Central Asia are regions where rates of HIV infection are increasing. Among the most affected are sexual and gender diverse (SGD) persons including men who have sex with men (MSM). In March 2020, the first COVID-19 cases were reported in Kazakhstan. Since then, the COVID-19 pandemic and measures to mitigate its spread have had a significant impact on public health service access as well as mental health of the general population. According to a recent UNAIDS assessment of health needs among the community of people living with HIV and key populations in Kazakhstan, 60% of respondents noted the need for psychological and other related consultations. The mental health of SGD persons in Kazakhstan in the context of COVID-19 pandemic has not been studied.

METHODS: To address this gap, we conducted a cross-sectional study to examine the mental health of 455 SGD persons in Kazakhstan’s three cities—Almaty, Nur-Sultan, and Shymkent, and its association with COVID-19 disruptions of HIV testing and treatment services. We used follow-up assessment data, collected from May through October of 2020, from the UNI Project, a NIDA-funded clinical trial of a social network-based intervention for increasing linkage to the HIV care continuum. The exposure variable, COVID-19 disruptions to accessing HIV-related services, assessed whether respondents ever experienced limitations in their ability to receive HIV testing or treatment due to COVID-19 (1=yes, 0=no). For response variables, DASS-21 (Henry & Crawford, 2005) subscales were used to measure emotional states of depression, anxiety, and stress. We applied linear regression analysis, adjusting for confounding effects of age, employment, gender, and sexual orientation.

RESULTS: Mean scores on DASS-21 subscales were 9.2, 8.2, 11.9 for depression, anxiety, and stress, respectively. These scores also indicated that 30.3% (n=138), 36.9% (n=168), and 17.6% (n=80) of the sample experienced at least moderate levels of depression, anxiety, and stress, respectively. In multivariable analyses, each of the DASS-21 subscales was significantly positively associated with endorsing COVID-19 disruptions in the ability to get HIV testing or treatment: depression (b(SE)=4.43(1.44), 95%CI=1.59-7.26, p=.002), anxiety (b(SE)=4.51(0.99), 95%CI=2.56-6.46, p<.001), and stress (b(SE)=4.13(1.20), 95%CI=1.78-6.48, p=.001).

CONCLUSIONS AND IMPLICATIONS: Findings are consistent with the worsening of psychological distress in the presence of the negative impacts of COVID-19 and COVID-19 mitigation measures on the ability of SGD persons in Kazakhstan to engage in the HIV care continuum. Programs that promote mental health among SGD persons may be valuable and have synergistic benefits for a population grappling with both COVID-19 and HIV in Kazakhstan.